Novel throws light on stress of infertility

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The main plot line in “What Alice Forgot” traces the title character’s amnesia and her attempt to recover 10 years of memories, but it was the depiction of her sister that I found most fascinating.

The sister struggles with infertility, and as a mental health clinician, I’m well aware that parenthood is one of the major transitions into adult life for both men and women. The non-fulfillment of the wish to have a child is clearly associated with a host of problems, and author Liane Moriarty skillfully examines some of them in her novel.

“What Alice Forgot” is set in Australia in 2008 and tells the story of 39-year-old Alice Love. She is a mother of three and is going through a messy divorce.

One day Alice wakes up on a gym floor after falling off her bike. She remembers little of how she got there, and in her mind, it’s 1998.

At 29, Alice was a delightful woman happily on the brink of motherhood, beloved by her sister, husband, and friends. But at 39, she has become uptight and judgmental. She resumes her life with her 29-year-old outlook and can’t comprehend the person she has become, but somehow has to find a way back to her present.

This clever and absorbing story is told from the point of view of the main character, her sister, and grandmother. The central tension in the book involves two questions. Will Alice regain her memory? And what will she do when she does?

The author does a fine job of exposing the reader to the ins and outs of amnesia. But I think the novel is at its best when illuminating the estrangement of Alice and her older sister Elizabeth, who resents Alice’s insensitivity to her infertility.

I have seen how such problems as anxiety, low self-esteem, social isolation, and increased marital discord result from the stress of infertility. Current research even shows that women who fail to conceive or successfully carry to term have clinical depression rates equivalent to women who have cancer or heart disease.

While both men and women experience a sense of loss, stigma, and feelings of defectiveness, in general women show higher levels of distress than men. For women, the stigma of infertility particularly derives from societal pressure that traditionally has seen childbearing as central to the female role. The author often alludes to this sense of inadequacy as the women themselves perceive that the world is split between “fertiles vs. infertiles.”

Moriarty also very skillfully highlights a frequent finding in therapy, that women trying to get pregnant often are subject to comments, even from loved ones, that seem to blame them for failure to conceive. They are told they waited too long, they are too “Type A,” or have allowed their anxiety to get in the way of getting pregnant. These comments can be internalized as a profound lack of support, prompting them to withdraw from social situations and become isolated.

Finally, even the process of in vitro fertilization and the intense commitment to treatment has its own psychological effects. Depending on the stage of treatment, women report experiencing distress because of the protracted nature of the process; the physical and emotional intrusiveness of repeated exams; mood changes from medication; and intense loss with each failed attempt or miscarriage.

South Shore gynecologist Deborah Wooten notes that the number of couples pursuing treatment for infertility seems to be increasing due to the trend of postponed child bearing, development of newer and more successful techniques, and increased access to assisted reproductive services.

Wooten observes that medical practitioners increasingly recognize the significant psychological impact of infertility and the consequences for women’s mood and well being.

She said she welcomes books like “What Alice Forgot,” which can “inspire a heightened awareness and sensitivity to the emotional aspects of infertility.”